Ovarian fossa

The uterine tubes lie on each side of the uterus in the upper margin of the broad Ugament (see Table 1.1 broad ligament). Each tube is attached on its inferior surface to a double fold of peritoneum called mesosalpinx (see Table 1.1). The lateral and superior part of the tube is the ampulla that opens into the funnel-shaped infimdibulum with its fimbria at the abdominal orifice. The ovaries lie in the ovarian fossa, i.e. close to the lateral pelvic wall and are suspended by a double fold of peritoneum, the mesovarium (see Table 1.1). The latter is attached to the broad ligament posteriorly. Behind the ovarian fossa are extraperitoneal structures, especially the ureter and the internal iliac vessels as well as the origin of the uterine artery (Fig. 1.14). 

Fig. 1.14. Axial section (400 pm) of a 24-week-old female fetus at a level with the ovarian fossa (arrow). X4...

Fig.8.1a,b. Ovarian fossa. Transaxial (a) and coronal T2-weighted (b) images in a 28-year-old female. Normal ovaries (arrows) are demonstrated in the ovarian fossa, which is a shallow peritoneal groove between external and internal iliac vessels. The ovaries are of ovoid shape and can be well identified due to follicles which display very high signal on the T2-weighting... 

Fig. 8.2a-c. Ovarian location in a woman of childbearing age. CT scans at the level of the uterine corpus (a-c) The right ovary (arrow) is located in the ovarian fossa (a). Atypical location of the left ovary (arrow) anterior to the uterine corpus near the anterior abdominal wall (b). A corpus luteum cyst (asterisk) displays attenuation values higher than water and a distinct enhancing wall (c)... 

Ovarian maldescent has an incidence of 0.2%-0.5% [22]. It may occur uni- or bilaterally and can be associated with Mullerian malformations [6]. In ovarian maldescent, ovaries may be found in an ectopic position along its migration pathway from the lumbar region to the ovarian fossa (Fig. 8.13). Rarely, ovaries... 

In women of childbearing age, ovaries in atypical positions can be identified on CT and MRI in the majority of patients due to the typical morphology of follicles. MRI is superior to CT for diagnosing mal-descended or ectopic ovaries due to their excellent visualization on T2-weighted images. Bowel contrast opacification will facilitate identification of ovaries in atypical positions. An ovary not visualized in the ovarian fossa should be sought in other locations in proximity to the uterus and above the pelvic brim, rarely may it be located near the inguinal canal. 

Fig. 9.15. Torsion of a paraovarian cyst. In a 14-year-old girl with severe acute pelvic pain a cystic lesion was found on sonography. CT shows normal ovaries in the ovarian fossa and a 7-cm cystic lesion (asterisk) in the cul-de-sac. The latter shows mild wall thickening at its left contour. Exploratory laparotomy found torsion of a right paraovarian cyst with involvement of the right fallopian tube. The ovaries were unremarkable...

Fig. 9.23. Polycystic ovaries in CT. Bilateral spherical ovaries (arrows) can be identified lateral of the uterine corpus in the ovarian fossa. Numerous uniformly sized follicles are found within the ovaries in this case of PCO, which was surgically verified...

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